Robotically assisted hysterectomy: 100 cases after the learning curve

To report on perioperative outcomes of robotic hysterectomy after the learning curve, we performed a retrospective review of our second 100 consecutive robotic hysterectomies performed by two surgeons between January 2007 and February 2008. Operative time following our learning curve was 79.3 ± 36.1 min. Patient age was 44.2 ± 9.6 years, body mass index (BMI) was 30.9 ± 8.3 kg/m2, and uterine weight was 223.7 ± 195.8 g. Indications for surgery included fibroids, menstrual disorders, and endometriosis. We performed total robotic-assisted laparoscopic hysterectomy type IVE. There were no conversions, no blood transfusions, and one cystotomy, repaired intraoperatively. Blood loss was 68.8 ± 105.8 cc, and average length of stay was 1.1 ± 0.3 days. There were no postoperative complications. Perioperative outcomes demonstrate low average operative times with a high level of safety on a broadened patient population, suggesting a potential advantage to using the robotic platform. Similar content being viewed by others

Farquhar CM, Steiner CA (2002) Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 99:229–234 Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB (1994) Hysterectomy in the United States, 1988–1990. Obstet Gynecol 83:549–555 Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, Marchbanks PA (2008) Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol 198:34e1–34e7. doi:10.1016/j.ajog.2007.05.039 Reich H (1989) New techniques in advanced laparoscopic surgery. Baillieres Clin Obstet Gynaecol 3:655–681 Kovac SR (1995) Guidelines to determine the route of hysterectomy. Obstet Gynecol 85:18–23 Bonilla DJ, Mains L, Whitaker R, Crawford B, Finan M, Magnus M (2007) Uterine weight as a predictor of morbidity after a benign abdominal and total laparoscopic hysterectomy. J Reprod Med 52:490–498 Kreiker GL, Bertoldi A, Larcher JS, Orrico GR, Chapron C (2004) Prospective evaluation of the learning curve of laparoscopic-assisted vaginal hysterectomy in a university hospital. J Am Assoc Gynecol Laparosc 11:229–235 Karaman Y, Bingol B, Gunenc Z (2007) Prevention of complications in laparoscopic hysterectomy: experience with 1120 cases performed by a single surgeon. J Minim Invasive Gynecol 14:78–84. doi:10.1016/j.jmig.2006.08.016 Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG (2007) Hysterectomy rates in the United States, 2003. Obstet Gynecol 110:1091–1095 Payne TN, Dauterive FR (2008) A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15:286–291. doi:10.1016/j.jmig.2008.01.008 Muzii L, Basile S, Zupi E, Marconi D, Zullo MA, Manci N, Bellati F, Angioli R, Benedetti Panici P (2007) Laparoscopic-assisted vaginal hysterectomy versus minilaparotomy hysterectomy: a prospective, randomized, multicenter study. J Minim Invasive Gynecol 14:610–615. doi:10.1016/j.jmig.2007.05.012 David-Montefiore E, Rouzier R, Chapron C, Darai E (2007) Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod 22:260–265. doi:10.1093/humrep/del336 Kluivers KB, Hendriks JC, Mol BW, Bongers MY, Bremer GL, de Vet HC, Vierhout ME, Brolmann HA (2007) Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol 14:145–152. doi:10.1016/j.jmig.2006.08.009 Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr (2002) Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc 16:1271–1273. doi:10.1007/s00464-002-8523-5 Advincula AP, Reynolds RK (2005) The use of robot-assisted laparoscopic hysterectomy in the patient with a scarred or obliterated anterior cul-de-sac. JSLS 9:287–291 Beste TM, Nelson KH, Daucher JA (2005) Total laparoscopic hysterectomy utilizing a robotic surgical system. JSLS 9:13–15 Marchal F, Rauch P, Vandromme J, Laurent I, Lobontiu A, Ahcel B, Verhaeghe JL, Meistelman C, Degueldre M, Villemot JP, Guillemin F (2005) Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients. Surg Endosc 19:826–831. doi:10.1007/s00464-004-9122-4 Fiorentino RP, Zepeda MA, Goldstein BH, John CR, Rettenmaier MA (2006) Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes. J Minim Invasive Gynecol 13:60–63. doi:10.1016/j.jmig.2005.11.001 Field JB, Benoit MF, Dinh TA, Diaz-Arrastia C (2007) Computer-enhanced robotic surgery in gynecologic oncology. Surg Endosc 21:244–246. doi:10.1007/s00464-006-0894-6 Reynolds RK, Advincula AP (2006) Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg 191:555–560. doi:10.1016/j.amjsurg.2006.01.011 Kho RM, Hilger WS, Hentz JG, Magtibay PM, Magrina JF (2007) Robotic hysterectomy: technique and initial outcomes. Am J Obstet Gynecol 197:113e1–113e4. doi:10.1016/j.ajog.2007.05.005 Boggess JF (2008) A comparative study of three surgical methods for hysterectomy with staging for endometrial cancer; robotic-assistance, laparoscopy, laparotomy. Am J Obstet Gynecol 199:360.e1–360.e9. doi:10.1016/j.ajog.2008.08.012 Boggess JF (2008) A case-control study of robotic assisted type III radical hysterectomy with pelvic lymph-node dissection compared to open radical hysterectomy. Am J Obstet Gynecol 199:357.e1–357.e7. doi:10.1016/j.ajog.2008.06.058 Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM (2008) Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol 109:86–91. doi:10.1016/j.ygyno.2008.01.011 Lowe MP, Chamberlain DH, Kamelle SA, Johnson PR, Tillmanns TD (2009) A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer. Gynecol Oncol. doi:10.1016/j.ygyno.2009.01.018 Visco AG, Advincula AP (2008) Robotic gynecologic surgery. Obstet Gynecol 112:1369–1384. doi:10.1097/AOG.0b013e31818f3c17 Johns DA, Carrera B, Jones J, DeLeon F, Vincent R, Safely C (1995) The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital. Am J Obstet Gynecol 172:1709–1715 (Discussion 1715–1719) Marana R, Busacca M, Zupi E, Garcea N, Paparella P, Catalano GF (1999) Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study. Am J Obstet Gynecol 180:270–275 Perino A, Cucinella G, Venezia R, Castelli A, Cittadini E (1999) Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod 14:2996–2999 Makinen J, Johansson J, Tomas C, Tomas E, Heinonen PK, Laatikainen T, Kauko M, Heikkinen AM, Sjoberg J (2001) Morbidity of 10,110 hysterectomies by type of approach. Hum Reprod 16:1473–1478 Seracchioli R, Venturoli S, Vianello F, Govoni F, Cantarelli M, Gualerzi B, Colombo FM (2002) Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Assoc Gynecol Laparosc 9:333–338 Falcone T, Paraiso MF, Mascha E (1999) Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy. Am J Obstet Gynecol 180:955–962 Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, Vadora E (2002) Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Am J Obstet Gynecol 187:1561–1565 Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA (2003) A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. Int J Gynaecol Obstet 83:37–43 Ahlering TE, Skarecky D, Lee D, Clayman RV (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170:1738–1741 Burgess SV, Atug F, Castle EP, Davis R, Thomas R (2006) Cost analysis of radical retropubic, perineal, and robotic prostatectomy. J Endourol 20:827–830 Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S (2008) Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol 111:407–411 Cook JA, Ramsay CR, Fayers P (2004) Statistical evaluation of learning curve effects in surgical trials. Clin Trials 1:421–427 Acknowledgments The authors would like to thank Usha Kreaden, Sr. Biostatistician at Intuitive Surgical for statistical assistance and April E. Hebert, Ph.D. a consultant for Intuitive Surgical, for literature review. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Payne, T.N., Dauterive, F.R. Robotically assisted hysterectomy: 100 cases after the learning curve. J Robotic Surg 4, 11–17 (2010). https://doi.org/10.1007/s11701-010-0174-2 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s11701-010-0174-2